Pressure on pharmacist is a recipe for danger

Errors are on the increase, but what's the prescription?

January 27, 2002|By Andrew Julien and Matthew Kauffman. Special to the Tribune. Andrew Julien and Matthew Kauffman are reporters for the Hartford Courant, a Tribune newspaper.

Patricia Quinn lay on a hospital bed two years ago, suffering serious internal bleeding while a priest solemnly administered last rites.

She had been sick for weeks, battling sluggishness and nausea she couldn't shake and didn't understand.

But today, after surviving that harrowing night at Bristol Hospital in Connecticut, Quinn said she understands only too well what nearly killed her. Three weeks before being rushed to the hospital, the Bristol woman had stopped by an Arrow Pharmacy in town to pick up a prescription for her thyroid medication, Tapazole. According to a lawsuit she later filed against Arrow, the pharmacist mistakenly filled Quinn's medicine bottle with Coumadin, a blood thinner.

Quinn's lawsuit, which since has been settled for an undisclosed amount, accused the pharmacist of trying to fill too many prescriptions at once, creating "an extreme departure from ordinary care, in a situation where a high degree of danger was apparent."

Today, however, the overworked pharmacist trying to fill too many prescriptions is anything but a departure from the ordinary. Rather, Quinn's tale highlights a growing health risk that even many pharmacists admit could get worse if dramatic steps aren't taken quickly.

With pressure on pharmacists increasing on several fronts, medication errors across the country are skyrocketing and are blamed for hundreds of deaths and thousands of injuries a year.

Number unknown

The exact number of errors is unknown because not all mistakes are detected, and fewer still are reported.

But the growth is unmistakable. In Connecticut, the number of consumer-reported pharmaceutical errors, a figure that hovered around 10 a year through much of the '80s and '90s, climbed to 75 in 2000.

It's the same story around the country. A nationwide survey last year found that nearly every state saw a surge in prescription-error cases during the mid-1990s.

For consumers, the only hint of trouble might be shorter hours and longer lines at the pharmacy. But those in the field see a coming crisis behind the counter. Squeezed on one side by shrinking reimbursements and on the other by increasing demand, pharmacists say their daily routine has been turned into a pressure-packed marathon in which errors are a tragic consequence.

"This is scaring me," said William P. Ward, chief of enforcement operations at the Connecticut consumer-protection department. "You've got medication errors out of control. You've got people standing in lines. It's a public health issue."

Medication errors are largely simple, sloppy mistakes. Two drugs sound the same. A doctor scrawls an illegible prescription. A pharmacist misreads a decimal point and administers an incorrect dosage. Two medication vials sitting side by side on a counter are inadvertently swapped.

Many errors are caught by the patients themselves, while others result in relatively minor harm. But with so many powerful drugs on the market to treat heart disease, diabetes, depression and a slew of other ailments, the consequences can be devastating.

Tragic errors

In California, a 5-year-old girl with cerebral palsy was given 100-milligram tablets of an anti-seizure medicine, instead of the 15-milligram pills her doctor ordered. The mix-up was blamed for a subsequent seizure that left her severely brain-damaged, leading to a $30 million verdict against Thrifty Payless Inc.

In South Carolina, a jury slammed a Rite Aid pharmacy with a $16 million judgment after a 7-year-old on Ritalin was instead given a medication diabetics use to lower their blood sugar. The girl went into a coma that left her with permanent brain damage.

But the mistakes go far beyond the few that make headlines. A recent survey by the trade magazine Drug Topics found that more than half of pharmacists admitted making a mistake over the previous 60 days.

The problem of pharmacy errors can be compounded by doctors, who frequently have only minutes to devote to each patient and often hastily scribble prescriptions in an effort to keep the conveyer belt moving.

That chicken scratch on a doctor's prescription pad was once part of the endearing lore of the profession. But with an explosion of easily confused drug names, and with computers readily available in most every medical office, critics are astounded that physicians still hand-write nearly all of the 3 billion prescriptions issued in the United States each year.

But Dr. Michael Deren, a former president of the Connecticut State Medical Society, said the number of medication errors caused by illegible handwriting is relatively small.

And although it might appear to be simple for doctors to move away from handwritten prescriptions, Deren said there are costs involved, and most doctors are still trying to cope with the harsher financial realities of managed care.

Manpower shortage

Likewise, pharmacists face pressures of their own, especially a lack of manpower.